We Asked A Pelvic Floor Expert To Answer Your Most Embarrassing Questions

Painful sex. Peeing when you cough. Lower back pain. They may seem like unrelated issues, but all three are common symptoms that can be treated with pelvic floor therapy (PFT). This practice has grown in popularity over the last decade, but WTF is it??

As the name suggests, PFT is a form of therapy that focuses directly on the bowl-shaped group of muscles and connective tissue that support the bladder, bowel, and reproductive organs. It can be effective in addressing pain and weakness, or just keeping everything running smoothly.

Opening up (literally) to a stranger about the most intimate parts of your body can feel embarrassing and intimidating. I spoke with Jamie Lief, OTD, OTR/L, PCES, a pelvic floor occupational therapist and Level 1 Functional Pelvic Health Practitioner, based in NYC, who answered questions from BuzzFeed readers!

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1. What everyday habit causes the most pelvic floor problems without people realizing it?

Dr. Lief’s immediate reaction to this was a very emphatic “squatting over toilets!” She explained that hovering — which engages the muscles in your legs, core, and pelvic floor — “goes against your body’s natural tendency to relax the pelvic muscles and allow the urethra to open.”

This might cause you to “push your pee out” or be unable to completely empty your bladder. While this is fine during the occasional horrifying porta-potty situation, doing it every day can “lead to even worse pelvic symptoms like urinary leakage and frequent urination.”

Also problematic? “Just-in-case” peeing, i.e., forcing yourself to pee before running errands or seeing a movie. “What you’re doing here is emptying your bladder before it’s full, which disrupts the natural urge signals your bladder sends.” Over time, she continued, “your body is going to get used to this, and you’re gonna end up peeing all the time, disrupting your life and teaching your bladder to function in unhealthy ways.”

2. What’s something people think is totally normal, but is actually a sign your pelvic floor isn’t working right?

Did you know difficulty pooping can be a sign of pelvic floor dysfunction?? I didn’t. The pelvic floor muscles support the end of the hose-like colon. According to Dr. Lief, “If those muscles are overly tense, uncoordinated, or not strong enough to help get the poop out, then you may feel the need to push hard to empty.”

That pushing, she said, can “weaken your muscles, leading to other pelvic symptoms” and eventually “put you at risk for hemorrhoids and rectal fissures, which can be very painful.”

3. What’s something your patients are usually embarrassed to ask you about, but absolutely shouldn’t be?

“Orgasms! Even my patients that are already seeing me for sexual dysfunction get anxious to talk about orgasms. I’m not sure why, because as we all know, this is the best part of sex. It is also highly affected by changes in the pelvic muscles.”

“Orgasms, although related to arousal and comfort levels, require your pelvic floor to be strong and have its full range of motion, i.e., be able to fully contract and relax.”

“Pelvic dysfunction can make orgasms weaker or difficult to get to at all. Never be afraid to bring up orgasms, because it’s a functional and pleasurable moment that everyone deserves to have.”

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4. Is there one exercise you wish people knew to do for pelvic health as they get older?

“Diaphragmatic breathing, 100%.” This is a technique that “engages the muscles in the diaphragm to relax the pelvic floor” and “can help with nervous system downregulation to combat muscle tension that may come from clenching during stress.”

As it relates to the pelvic floor, Dr. Lief explained that it “allows for healthy movement of the pelvic muscles, helps release tension, aids in muscle relaxation when using the bathroom, and can physically prepare your body for intercourse.”

As an added perk, it’s been shown to reduce lower back pain, abdominal tension, and even anxiety. “In short, I believe this is the best thing you can do for your pelvic floor, no matter who you are.”

5. Wait, is it not normal for sex to be a little painful?

“Nope, nope, nope!” If everything is working correctly, penetrative sex should not be a painful experience. “If your pelvic muscles are not functioning to the best of their ability, you may have pain with insertion or deeper into the vaginal canal with penetration.”

Of course, sex isn’t just penetrative, and orgasms can be achieved in many other ways. Regardless of what gets you off, penetration “still should not hurt. If it does, and you’re also noticing that Pap smears, use of tampons, or finger insertion are painful, you might seriously benefit from pelvic floor therapy.”

6. Should I do Kegels if my pelvic floor is healthy? Will it cause pelvic floor issues to appear?

Kegeling is NOT a pelvic floor cure-all. While Kegeling can support a healthy pelvic floor, it can actually do more harm than good if you’re overly tense to begin with. “If the muscles are already constricted, then squeezing them may contribute to increased tension. It’s very important NOT to assume that your pelvic floor muscles just need strength training to mitigate pelvic symptoms.”

Kegeling is an exercise in which the pelvic floor muscles are repeatedly contracted and relaxed to strengthen and support the pelvic floor and the organs within.

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7. I sometimes feel the urge to pee, and before I can even attempt to Kegel, I’ve leaked. How do I prevent split-second leakages?

As mentioned above, Kegels aren’t a cure-all for all pelvic floors. So what can help, no matter what kind of pelvic floor you have? “DIAPHRAGMATIC BREATHING!” Learning to breathe in a slow, intentional way can be an essential tool for stopping those split-second leaks.

“Breathe right down into your pelvic floor muscles when you feel the urge to urinate. This can help calm the urge, support your urethra, and calm your nervous system, all of which can help prevent leakage.”

8. What should a young guy look out for that may be related to pelvic floor dysfunction?

According to Dr. Lief, those with penises are less likely to address pelvic floor issues, in large part because there’s a lot of anxiety in discussing intimate issues. That, however, doesn’t mean those issues don’t exist.

“Those with penises also have pelvic floors, and all pelvic floors can be prone to changes in tension, weakness, and discoordination. Pelvic pain (including painful ejaculation), constipation, and erectile dysfunction are all symptoms that can be addressed through PFT.”

Many of these cases go unreported and/or untreated, but “pelvic therapy can be just as beneficial for people who have a penis as it is for those with vaginal canals.”

9. What other areas of the body can the pelvic floor refer pain to? Can it be the cause of lower back pain?

Pelvic floor issues don’t only affect the pelvis, Dr. Lief explained. The pelvis is supported by the muscles in the core, back, glutes, hips, and pelvic floor, which “wrap around the pelvis like Saran Wrap. When they’re strong, the Saran Wrap is strong and stabilizing. When the pelvic floor is weak or has some kind of dysfunctional habits…the other muscles have to compensate for the pelvic floor’s lack of support.”

If your back, for example, is working overtime to support the pelvis, that can increase your back pain. “By addressing the strength of the entirety of the Saran Wrap, including your pelvic floor, you can increase support to the pelvis, distribute the workload of support, and likely reduce back pain.”

So, if you feel like you’ve tried everything else to solve your back pain, with minimal results, Dr. Lief believes this makes you a good candidate for a pelvic evaluation “to see if this is a contributing factor.”

10. Is it normal to pee 7+ times a day?

Before answering this question, Dr. Lief made it very clear that every body is different and there is no normal pee-per-day ratio we should all be striving for. Generally, though, peeing every two to four hours is healthy, depending on how much a person drinks.

“Peeing more than every two hours and less than every four hours are both considered problematic. If you are the friend that says, ‘Oh, I just have a tiny bladder’ every time you go see a movie or have long car rides, it may be helpful to see whether you’ve developed frequent urination habits over time.” If it doesn’t really bother you, she said, “there’s no reason to stress,” although you can retrain your bladder to change your urination frequency.

All that being said, “if frequent urination is compensating for trying to avoid a urine leak, or if it’s something you developed due to anxiety about peeing, that’s another story, and is something to discuss with a PFT.”

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11. Can you cause issues with the pelvic floor muscles by constantly sucking in your stomach?

Yes, yet another reason to stop sucking in your stomach is that it can negatively impact the pelvic floor. “When you suck in [your stomach] all day long, you’re basically engaging the abdominal muscles all day long.”

The abdominal and pelvic muscles work together (remember the Saran Wrap metaphor?); so “if you’re using your abdominal muscles to suck in all day, then your pelvic muscles are also active and contracted all day, [which can] increase your tension and, in turn, some of your pelvic symptoms.”

Dr. Lief recommends letting your stomach relax for a few days: “Get to know how that feels, and your body will relearn that it’s okay to allow the abdominal muscles to rest.”

“Once those muscles are rested, your pelvic floor will get the chance to rest as well.” Of course, this doesn’t mean you should stop doing your planks and Pilates — “I’m specifically talking about limiting activation all day, every day; you wouldn’t do bicep curls all day long, would you?”

12. And finally, is there a correlation/effect on pelvic floor health and endometriosis? How do I strengthen my pelvic floor to ensure my body is healthy?

Yes, there’s a correlation, Dr. Lief confirmed. Endometriosis is a “complex issue,” but, generally, “pelvic floor tension often occurs as a protective response to pain and anxiety.” Because pain and anxiety go hand-in-hand with endometriosis, this can turn into a vicious cycle. “Endometriosis pain causes muscle tension, muscle tension causes pelvic pain, which causes more tension, which causes more pain, and on and on.”

Another potential side effect? “Urinary and bowel symptoms may also worsen.” Unfortunately, PFT can’t cure endometriosis, but Dr. Lief reassured me that there are so many ways that it can “help the pelvic muscles become/stay as healthy as possible, break that pain cycle, and teach nervous system strategies to combat pain and tension.”

Have you gone to pelvic floor therapy? Share your experiences in the comments!

Check out more from Dr. Lief here!

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